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'A Huge Deal': Biden Rebuffs Georgia's Medicaid Work Requirement--Last in US
"By ending work requirements in many states, Biden is erasing one of Trump's cruelest legacies."
Dec 24, 2021
After the White House on Thursday rejected a proposal to impose work requirements on Medicaid recipients in Georgia--the last state with a federal waiver permitting such restrictions--President Joe Biden received praise for "quietly erasing" one of his predecessor's "cruelest legacies."
"The announcement from the Centers for Medicare & Medicaid Services, delivered in a 79-page letter to Georgia's health agency, also reversed a federal waiver allowing the state to charge premiums for the health insurance program for the poor," according to the New York Times.
The Times reported:
Georgia had not yet imposed the proposed work requirements--which limited Medicaid eligibility to those who work at least 80 hours a month--but it could have started the restrictions as early as next week, according to correspondence between the state and federal health agencies.
The premiums that Georgia proposed had also not been enacted. The Medicaid agency said that it was revoking the authority to charge the premiums because those fees "can present a barrier to coverage" and worsen healthcare inequality.
Biden's move dealt "a critical blow to the already reeling effort to attach work requirements to Medicaid," the newspaper noted. "The movement by more than a dozen states managed in practice to enact work requirements in only a few--and only for a short time--as it faced court setbacks, a pandemic, and a new administration that has steadily dismantled such initiatives."
Washington Post columnist Greg Sargent called Biden's elimination of Georgia's Medicaid work requirements--the last remaining proposal of its kind in the U.S.--"a huge deal."
\u201cA huge deal: Biden just reversed the Medicaid work requirement in Georgia. By ending work requirements in many states, Biden is erasing one of Trump's cruelest legacies -- even as the ACA Trump tried to destroy is expanding.\n\nNew from @paulwaldman1 and me:\nhttps://t.co/XSkUQWh3Vu\u201d— Greg Sargent (@Greg Sargent) 1640361643
In 2018, Seema Verma, then-director of the Centers for Medicare & Medicaid Services under former President Donald Trump, issued guidance allowing states to apply for a waiver to significantly alter eligibility requirements for Medicaid, a Great Society-era program on which 76 million low-income adults, people with disabilities, and children rely for health insurance.
Nearly 20 Republican-led states quickly jumped at the opportunity to take healthcare away from poor and vulnerable Americans, and the Trump administration ultimately approved policies to deny Medicaid coverage to people who didn't comply with strict work requirements in 13 states.
The Biden White House in February invalidated the previous administration's guidance allowing states to apply for Medicaid eligibility restriction waivers and notified states that had already been given permission to impose work requirements that the policies would soon be reversed due to the detrimental impact of coverage loss on Medicaid recipients, particularly during the Covid-19 pandemic, as Common Dreams reported at the time.
After the Biden administration in March told Medicaid officials in New Hampshire and Arkansas--which was the first and only state to fully implement Medicaid work requirements, taking healthcare away from at least 18,000 people over a period of several months in 2018--that approval for such policies had been revoked, progressives urged the White House to forge ahead with its plan to withdraw all remaining Medicaid work requirements nationwide, which it has done.
"This is a genuine achievement, in both symbolic and practical terms," Sargent and Paul Waldman wrote Friday of Biden's successful neutering of Trump's signature attack on healthcare.
Biden's rejection of Georgia's proposal "was effectively the last nail in the coffin of Trump's zombie attempt to make Medicaid more cumbersome and bureaucratic, in hopes of knocking as many people off health coverage as possible," argued the pair.
According to Sargent and Waldman:
Trump's effort to impose Medicaid work requirements was part of a much larger campaign to undermine and roll back our country's fitful advance toward universal healthcare. This constituted an even broader legacy of cruelty, and arguably outright betrayal.
That's because Trump campaigned in 2016 as a corrective to Paul Ryan-style Republicans who had treated destroying the social safety net as a quasi-religious calling. Trump vowed that "everybody's got to be covered," and insisted no one would die on the street, uninsured.
Once in office, however, "Trump embraced GOP anti-safety-net zealotry by going all in on the Republican effort to destroy the Affordable Care Act," they continued. "That culminated in the 2017 repeal attempt, which fortunately failed. Stymied in that effort, which would have taken coverage away from millions on the ACA's Medicaid expansion, Trump sought to weaken the safety net via other administrative means, such as these Medicaid work requirements."
"And so, in erasing those requirements," Sargent and Waldman added, "Biden is also erasing a larger hangover of Trumpian cruelty."
Sargent and Waldman noted that "the same ACA that Trump tried to destroy is expanding" because the American Rescue Plan signed by Biden in March enhanced ACA subsidies and widened eligibility for them. However, they pointed out, "the ACA expansion in the rescue package expires at the end of next year."
Although the vast majority of congressional Democrats want to extend the ACA expansion by passing the Build Back Better Act, right-wing Democratic Sen. Joe Manchin's (W. Va.) opposition to the legislation puts beefed-up healthcare subsidies at risk, hurting millions of low-income Americans and potentially jeopardizing Democrats' electoral performance.
"If Democrats aren't able to extend it, millions of people will get notice of huge premium increases right before the midterm election," Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, told Sargent and Waldman.
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Biden Urged to Withdraw All Medicaid Work Requirements Approved by Trump
Policies to "take Medicaid coverage away from people who don't comply with stringent work requirements... are deeply harmful."
Apr 05, 2021
While the White House in recent weeks has taken steps to overturn a Trump-era initiative enabling states to restrict Medicaid eligibility by imposing punitive work requirements, healthcare advocates on Monday urged President Joe Biden to rescind all Medicaid work requirement policies approved by his predecessor.
"Uninsurance rates among people subject to the work requirement rose, but their employment rates didn't."
--Jennifer Wagner, CBPP
In 2018, Seema Verma, then-director of the Centers for Medicare and Medicaid Services under former President Donald Trump, issued guidance allowing states to apply for a waiver to significantly alter eligibility requirements for Medicaid, a Great Society-era program on which more than 72 million low-income adults, people with disabilities, and children rely for health insurance.
Several Republican-led states quickly jumped at the offer to strip healthcare away from poor and vulnerable Americans, and the Trump administration ultimately approved policies to "take Medicaid coverage away from people who don't comply with stringent work requirements" in 13 states, as Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities (CBPP), noted Monday in a blog post.
While litigation and the coronavirus pandemic have put the implementation of work requirement policies "on hold," Wagner stressed that "taking coverage away from enrollees or otherwise conditioning coverage on meeting a work requirement doesn't further Medicaid's purposes," which exists to provide healthcare to the impoverished. "Accordingly," she added, "the Biden administration should now withdraw all of the previous approvals."
\u201cThe Trump admin approved policies in 13 state demo projects that take #Medicaid coverage away from people who don\u2019t comply with stringent work requirements.\n\nThe Biden admin should now withdraw all of the previous approvals.\n\nhttps://t.co/rIHI3ndkPr\u201d— Center on Budget (@Center on Budget) 1617634294
The White House in February invalidated the previous administration's guidance allowing states to apply for Medicaid eligibility restriction waivers and notified states that had already been given permission to impose work requirements that the policies would soon be reversed due to the detrimental impact of coverage loss on Medicaid recipients, particularly during the pandemic, as Common Dreams reported at the time.
Last month, the Biden administration told Medicaid officials in New Hampshire and Arkansas--which was the first and only state to fully implement Medicaid work requirements, taking healthcare away from at least 18,000 people over a period of several months in 2018--that approval for their work requirement policies had been rescinded.
While "Georgia, Indiana, Nebraska, Ohio, South Carolina, and Utah have objected" to Biden's efforts to dismantle Medicaid work requirements, Wagner reiterated that "the administration should nevertheless continue with its plan."
"These policies inevitably lead to eligible enrollees losing coverage--work requirements can't be fixed."
--Wagner
Wagner continued: "The Trump administration claimed that requiring work or other activities as a condition of coverage would 'improve beneficiaries' health,' ignoring evidence from other programs suggesting these restrictions would significantly harm Medicaid enrollees. After states began implementing these policies, their experiences confirmed the harmful effects of work requirements."
Citing a new analysis from the Department of Health and Human Services, Wagner wrote that "these policies are deeply harmful to Medicaid enrollees and confirms that they don't promote Medicaid's objectives."
Referring to the 18,000 Arkansas residents who lost Medicaid coverage in 2018, Wagner said that "uninsurance rates among people subject to the work requirement rose, but their employment rates didn't."
Arkansans "who lost coverage were more likely to have chronic conditions, and many had difficulty paying their medical bills and accessing healthcare and medications," she continued. "Data from New Hampshire and Michigan also show a significant loss of coverage would have occurred if the states' work requirement policies had been implemented, largely due to enrollees' limited awareness of the policies and challenges in reporting compliance."
"The evidence of the detrimental impact of work requirements from Arkansas, New Hampshire, and Michigan demonstrates that other state policies would face the same challenges and harmful consequences," she added. "All policies that take away coverage from people not meeting work requirements are marred by complex rules about who is exempt and what activities count, challenges communicating with enrollees, and burdensome paperwork and reporting requirements. These policies inevitably lead to eligible enrollees losing coverage--work requirements can't be fixed."
According to Wagner, "There's nothing left to demonstrate by letting more states take risks with Medicaid enrollees' health. The Centers for Medicare and Medicaid Services should withdraw all waiver authority for policies that take coverage away from people not meeting work requirements or otherwise condition coverage or benefits on meeting them and make clear that these policies won't be allowed in Medicaid."
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Biden Plans to Rescind Medicaid Work Requirements, Targeting One of Most 'Cruel' Policies of Trump Era
"We celebrate this win—this win that we made happen—even while mourning the loss of every person who relied on Medicaid and didn't survive the calamity of Trump's disastrous administration."
Feb 11, 2021
The Biden administration on Friday is expected to begin the process of rescinding a Trump policy allowing states to impose punitive work requirements on Medicaid recipients, a move celebrated as a crucial step toward reversing one of the former president's most vicious attacks on the poor and vulnerable.
According to the Washington Post, which obtained a draft of the Biden administration's plan, federal health officials on Friday "will withdraw their predecessors' invitation to states to apply for approval to impose such work requirements and will notify 10 states granted permission that it is about to be retracted."
The brainchild of Seema Verma, head of the Centers for Medicare and Medicaid Services under Trump, the work requirements initiative began in 2018 with guidance allowing states to apply for a waiver to significantly alter Medicaid eligibility requirements. Several Republican-led states quickly jumped at the offer; Arkansas, the first and only state to fully implement Medicaid work requirements, threw at least 18,000 people off the healthcare program over a period of several months in 2018.
While the destructive efforts of Arkansas and other states were largely stymied by federal court interventions, the Biden administration's plan to roll back the Trump work requirements guidance was applauded as key progress toward definitively ending one of the former president's most prominent efforts to strip healthcare from low-income people.
"We worked so very hard for this," Matthew Cortland, an attorney and disability rights activist, said of the effort to defeat the work requirements. "We celebrate this win--this win that we made happen--even while mourning the loss of every person who relied on Medicaid and didn't survive the calamity of Trump's disastrous administration."
Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, argued in a series of tweets late Thursday that "the Trump administration's Medicaid work requirement policy was never really about work," noting that "93% of Medicaid beneficiaries who are not on Medicare or SSI are already working, taking care of a family member, going to school, or not working due to illness."
"Medicaid work requirements have roots in the ideology that healthcare under Medicaid should be considered welfare for the deserving poor rather than a right," Levitt added.
\u201cMore great news: Pres Biden is moving fast to dismantle trump\u2019s cruel attempts to steal Medicaid from our most vulnerable neighbors.\u201d— Bill Pascrell, Jr. \ud83c\uddfa\ud83c\uddf8\ud83c\uddfa\ud83c\udde6 (@Bill Pascrell, Jr. \ud83c\uddfa\ud83c\uddf8\ud83c\uddfa\ud83c\udde6) 1613083868
In a last-ditch effort to preserve the work requirements policy during the final weeks of the Trump administration, Verma "asked states to sign contracts that would establish a lengthy process for unwinding work requirements and other conservative changes to their Medicaid programs," Politico reported Thursday.
"Medicaid experts have questioned whether those contracts are legally enforceable," the outlet noted.
The Biden administration's plan--which points to the ongoing coronavirus pandemic as a major reason to end the Trump era guidance--will come over a month before the U.S. Supreme Court is set to hear a case on the legality of the Medicaid work requirements. According to the the Wall Street Journal, Biden health officials are "expected to move quickly to end work requirements in Medicaid... because doing so could moot" the Supreme Court case.
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